Oct. 4, 1999 (Washington) -- With the House of Representatives about to debate managed care reforms, a famous children's story yesterday served as an apt metaphor for the politics ahead. Moderate Rep. James Greenwood (R, Pa.) likened his consideration of the three "patient protection" bills the House will consider later this week to Goldilocks tasting porridge. Which bill is neither too hot nor too cold, Greenwood asked, but "just right"?
The House debate and vote will occur this Wednesday and/or Thursday. For the moment, only one bill, the bipartisan measure from Reps. Charlie Norwood (R, Ga.) and John Dingell (D, Mich.), appears to have a majority of the House on board. But Reps. Tom Coburn, MD (R, Okla.) and John Shadegg (R, Ariz.) have a more modest set of proposals with which they hope to woo Republicans away. The American Medical Association backs only the Norwood/Dingell legislation, although other key physician lobbies have backed both that measure and the Coburn/Shadegg plan.
Coburn and Shadegg picked up key GOP firepower yesterday with the addition to their ranks of Greenwood and Bill Thomas (Calif.), chairman of the Ways and Means health subcommittee.
A relatively modest plan from Rep. John Boehner (R, Ohio) is the third bill in the mix. Also to be considered is a GOP leadership "access" package of tax breaks for the purchase of health insurance. The tax bill includes a controversial expansion of medical savings accounts.
The centerpiece of the debate is the liability of health plans. No current right of suit exists for patients, although insurers and businesses claim that expanding liability will increase costs and decrease coverage.
The Norwood plan would permit suits in state courts, while the Coburn bill allows suits -- with award caps -- only in federal court, and under stricter conditions. By contrast, the Boehner measure -- and the bill that passed the Senate this summer -- offers no right of suit to the aggrieved health consumer.
The Norwood bill appeared to suffer a setback yesterday, with its sponsors announcing that they would require $7 billion in offsets for lost federal tax revenues from higher medical premiums the bill could bring.
The announcement came as the House's Rules Committee heard testimony for hours from various lawmakers who argued that their particular amendments be made "in order" for the debate. Among more than 50 amendments proposed was one from Commerce Committee Chairman Tom Bliley (R, Va.) to give the public access to information on malpractice judgments against physicians.
The rules panel has the power to set the debate's parameters. With patient protection reformers at odds to varying degrees with House Republican leaders, the committee may attempt to shape the floor rules to the leaders' best possible advantage.
For example, Republican leaders have floated the possibility of forcing a final House vote on a combined patient protection/access package. But Norwood and Dingell emphasized yesterday that that would endanger passage for both bills. Democrats who otherwise support the patient protection bill, for example, might balk at the tax provisions.
"I understand the objection," Shadegg tells WebMD. He says that forcing a vote on a joint plan might be unreasonable. But he says that the House should send a joint protection/access bill to the Senate for conference negotiations.
Meanwhile, Republican leaders attempted to seize on the Census Bureau's announcement yesterday that the ranks of the nation's uninsured have swelled by 1 million to a total of more than 44 million. House Speaker Dennis Hastert (R, Ill.) complained, for example, that "most Democrats and some Republicans have been touting particular managed care bills that lead to higher costs and more uninsured [Americans]."